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Can J Cardiol. 2018 May;34(5):506-525. doi: 10.1016/j.cjca.2018.02.022. Epub 2018 Mar 1.

Hypertension Canada's 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children.

Author information

1
Division of General Internal Medicine, Departments of Medicine, Obstetrics and Gynecology, Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Electronic address: kara.nerenberg@ucalgary.ca.
2
O'Brien Institute for Public Health and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
3
Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
4
Department of Medicine and Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
5
Departments of Medicine and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada.
6
Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
7
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
8
Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.
9
Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
10
Université de Montréal, Montréal, Quebec, Canada.
11
Department of Medicine, Université Laval, Québec, Quebec, Canada.
12
McMaster University, Hamilton, Ontario, Canada.
13
CHU-Québec-Hopital St. Sacrement, Québec, Quebec, Canada.
14
Alberta Health Services and Covenant Health, Edmonton, Alberta, Canada.
15
Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
16
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
17
McGill Comprehensive Health Improvement Program (CHIP), Montreal, Quebec, Canada.
18
Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
19
St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
20
Departments of Medicine and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada.
21
Director of Stroke, Heart and Stroke Foundation of Canada, Adjunct Faculty, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
22
Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
23
McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, Ontario, Canada.
24
University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada.
25
McGill University, Stroke Prevention Clinic, Montreal General Hospital, Montreal, Quebec, Canada.
26
Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
27
Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada.
28
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
29
Department of Medicine, Western University, London, Ontario, Canada.
30
Université de Montréal, Institut de cardiologie de Montréal, Montréal, Quebec, Canada.
31
Institut National d'Excellence en Sante et Services Sociaux, Québec, Quebec, Canada.
32
Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
33
Winnipeg Regional Health Authority and the University of Manitoba, Winnipeg, Manitoba, Canada.
34
University of Quebec at Montreal (UQAM), Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada.
35
CHUM, University of Montreal, Montreal, Quebec, Canada.
36
Internal Medicine, Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada.
37
Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
38
LifeLabs Inc, McMaster University, Hamilton, Ontario, Canada.
39
University of Toronto, Toronto, Ontario, and Northern Ontario School of Medicine, Sudbury, Ontario, Canada.
40
University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada.
41
Department of Medicine, UBC Southern Medical Program, Kelowna, British Columbia, Canada.
42
University of Manitoba, Winnipeg, Manitoba, Canada.
43
Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada.
44
Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
45
University of Ottawa Heart Institute, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
46
Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
47
University Health Network, Toronto Rehab and Peter Munk Cardiac Centre, Toronto, Ontario, Canada.
48
Department of Medicine, McMaster University, Hamilton, Ontario, and Canadian Collaborative Research Network, Brampton, Ontario, Canada.
49
Department of Exercise Science, Concordia University, and Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada.
50
Department of Family and Emergency Medicine, Université de Montréal and CRCHUM, Montréal, Quebec, Canada.
51
Division of Internal Medicine, Department of Medicine, McGill University, Montréal, Quebec, Canada.
52
University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
53
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
54
Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada.
55
Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
56
University of Toronto, Toronto, Ontario, Canada.
57
Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada.
58
Division of General Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
59
Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.
60
Service de néphrologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.
61
Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
62
Department of Pediatrics, Division of Nephrology, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.
63
Department of Women and Children's Health, St Thomas' Hospital, London, and Department of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
64
Mount Sinai Hospital, Toronto, Ontario, Canada.
65
Université de Sherbrooke, Sherbrooke, Quebec, Canada.
66
CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada.
67
Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
68
University of British Columbia, Vancouver, British Columbia, Canada.
69
Interlake-Eastern Regional Healthy Authority, Concordia Hospital, Winnipeg, Manitoba, Canada.
70
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
71
Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Departments of Medicine and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada.

Abstract

Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines are introduced, and 1 existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke is revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hypertension should have an assessment of global cardiovascular risk to promote health behaviours that lower blood pressure. Finally, an angiotensin receptor-neprilysin inhibitor combination should be used in place of either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in individuals with heart failure (with ejection fraction < 40%) who are symptomatic despite appropriate doses of guideline-directed heart failure therapies. The specific evidence and rationale underlying each of these guidelines are discussed.

PMID:
29731013
DOI:
10.1016/j.cjca.2018.02.022
[Indexed for MEDLINE]

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